Provider Demographics
NPI:1114010006
Name:MILLER, JEFFREY HAINLIN (DO)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:HAINLIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PLANTATION ROAD
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440
Mailing Address - Country:US
Mailing Address - Phone:928-346-4679
Mailing Address - Fax:928-346-4686
Practice Address - Street 1:1607 PLANTATION ROAD
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440
Practice Address - Country:US
Practice Address - Phone:928-346-4679
Practice Address - Fax:928-346-4686
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006095207Q00000X
PAOS006293L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018490760001Medicaid
PA1866133OtherHIGHMARK
AZ899447Medicaid
PA618231Medicare PIN